TY - JOUR
T1 - The Ethical Obligation to Treat Infectious Patients
T2 - A Systematic Review of Reasons
AU - Grisel, Braylee
AU - Kaur, Kavneet
AU - Swain, Sonal
AU - Gorenshtein, Laura
AU - Chime, Chinecherem
AU - Callaghan, Ellen O.
AU - Vasireddy, Avani
AU - Moore, Lauren
AU - Shin, Christina
AU - Won, Michelle
AU - Ebangwese, Santita
AU - Tripoli, Todd
AU - Lumpkin, Stephanie
AU - Ginsberg, Zachary
AU - Cantrell, Sarah
AU - Freeman, Jennifer
AU - Agarwal, Suresh
AU - Haines, Krista
N1 - Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2024/8/15
Y1 - 2024/8/15
N2 - During pandemics, healthcare providers struggle with balancing obligations to self, family, and patients. While HIV/AIDS seemed to settle this issue, coronavirus disease 2019 (COVID-19) rekindled debates regarding treatment refusal. We searched MEDLINE, Embase, CINAHL Complete, and Web of Science using terms including obligation, refusal, HIV/AIDS, COVID-19, and pandemics. After duplicate removal and dual, independent screening, we analyzed 156 articles for quality, ethical position, reasons, and concepts. Diseases in our sample included HIV/AIDS (72.2%), severe acute respiratory syndrome (SARS) (10.2%), COVID-19 (10.2%), Ebola (7.0%), and influenza (7.0%). Most articles (81.9%, n = 128) indicated an obligation to treat. COVID-19 had the highest number of papers indicating ethical acceptability of refusal (60%, P < .001), while HIV had the least (13.3%, P = .026). Several reason domains were significantly different during COVID-19, including unreasonable risks to self/family (26.7%, P < .001) and labor rights/workers’ protection (40%, P < .001). A surge in ethics literature during COVID-19 has advocated for permissibility of treatment refusal. Balancing healthcare provision with workforce protection is crucial in effectively responding to a global pandemic.
AB - During pandemics, healthcare providers struggle with balancing obligations to self, family, and patients. While HIV/AIDS seemed to settle this issue, coronavirus disease 2019 (COVID-19) rekindled debates regarding treatment refusal. We searched MEDLINE, Embase, CINAHL Complete, and Web of Science using terms including obligation, refusal, HIV/AIDS, COVID-19, and pandemics. After duplicate removal and dual, independent screening, we analyzed 156 articles for quality, ethical position, reasons, and concepts. Diseases in our sample included HIV/AIDS (72.2%), severe acute respiratory syndrome (SARS) (10.2%), COVID-19 (10.2%), Ebola (7.0%), and influenza (7.0%). Most articles (81.9%, n = 128) indicated an obligation to treat. COVID-19 had the highest number of papers indicating ethical acceptability of refusal (60%, P < .001), while HIV had the least (13.3%, P = .026). Several reason domains were significantly different during COVID-19, including unreasonable risks to self/family (26.7%, P < .001) and labor rights/workers’ protection (40%, P < .001). A surge in ethics literature during COVID-19 has advocated for permissibility of treatment refusal. Balancing healthcare provision with workforce protection is crucial in effectively responding to a global pandemic.
KW - COVID-19
KW - HIV
KW - ethics
KW - health policy
KW - healthcare provision
UR - http://www.scopus.com/inward/record.url?scp=85201486490&partnerID=8YFLogxK
U2 - 10.1093/cid/ciae162
DO - 10.1093/cid/ciae162
M3 - Review article
C2 - 39149937
AN - SCOPUS:85201486490
SN - 1058-4838
VL - 79
SP - 339
EP - 347
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 2
ER -